Milán Vecsey-Nagy , Tilman Emrich , Giuseppe Tremamunno , Dmitrij Kravchenko , Muhammad Taha Hagar , Gerald S. Laux , U. Joseph Schoepf , Jim O'Doherty , Melinda Boussoussou , Bálint Szilveszter , Pál Maurovich-Horvat , Thomas Kroencke , Ismail Mikdat Kabakus , Pal Spruill Suranyi , Akos Varga-Szemes , Josua A. Decker
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引用次数: 0
Abstract
Background
The increased specificity of ultrahigh-resolution (UHR) photon-counting detector (PCD)-CT over energy-integrating detector (EID)-CT for coronary CT angiography (CCTA) could defer unwarranted downstream tests. The objective of the study was to simulate the cost-effectiveness of UHR CCTA in stable chest pain patients with coronary calcifications.
Methods
A decision and simulation model was developed using Monte Carlo simulations with 1000 bootstrap resamples to estimate the costs associated with PCD-CT in lieu of EID-CT for CCTA and the referral for subsequent testing. The model was constructed using the diagnostic accuracy metrics of 55 coronary lesions in patients who underwent CCTA on both CT systems and subsequent invasive coronary angiography (ICA). Sensitivity and specificity were defined for each Coronary Artery Disease Reporting and Data System category. The aggregate healthcare expenditures were derived from the hospital billing system.
Results
Assuming a projected cohort of 15,000 patients over the lifetime of the PCD-CT, its implementation resulted in a 18.9 % reduction in the number of functional follow-up tests (6330.3 ± 59.5 vs. 5135.7 ± 60.6, p < 0.001), a 6.0 % reduction in performed ICAs (1447.7 ± 36.2 vs. 1360.2 ± 34.7, p < 0.001), and a 9.4 % decrease in major procedure-related complications. Over a 10-year expected life expectancy, PCD-CT led to an average cost saving of $794.50 ± 18.50 per patient and an overall cost difference of $11,917,500 ± 4,350,169.
Conclusions
PCD-CT has the potential to reduce the financial burden on healthcare systems and procedure-related complications for stable chest pain patients with coronary calcification when compared to EID-CT.
期刊介绍：
The Journal of Cardiovascular Computed Tomography is a unique peer-review journal that integrates the entire international cardiovascular CT community including cardiologist and radiologists, from basic to clinical academic researchers, to private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our cardiovascular imaging community across the world. The goal of the journal is to advance the field of cardiovascular CT as the leading cardiovascular CT journal, attracting seminal work in the field with rapid and timely dissemination in electronic and print media.
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